Scrub typhus, also known as bush typhus, is a disease caused by bacteria called Orientia tsutsugamushi. Scrub typhus is spread to people through bites of infected chiggers (larval mites). The most common symptoms of scrub typhus include fever, headache, body aches, and sometimes rash. Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or traveling to areas where scrub typhus is found could get infected.

SIGNS AND SYMPTOMS
Symptoms of scrub typhus usually begin within 10 days of being bitten. Signs and symptoms may include:
 Fever and chills
 Headache
 Body aches and muscle pain
 A dark, scab-like region at the site of the chigger bite (also known as eschar)
 Mental changes, ranging from confusion to coma
 Enlarged lymph nodes
 Rash

INDIAN SCENARIO

In India, scrub typhus has been reported from Rajasthan, Jammu & Kashmir and Vellore. In addition, few cases have been tested positive for IgM antibodies for scrub typhus from Sikkim, Darjeeling, Nagaland & Manipur (unpublished data). In a study conducted from July through October 2004 in Himalayas, among several cases of acute febrile illness of unknown origin, O.tsutsugamushi was identified as causative agent by microimmunofluorescence and PCR. In an entomologic study in Himachal Pradesh, vector species Leptotombidium deliense and Gahrliepia spp. were recorded.

In Sikkim in 2008 cases of fever with multi system failure and death reported from west & south district of Sikkim. Few blood samples were sent to NCDC Delhi for confirmation of diagnosis from west and south district, out of sample sent nine samples came positive for scrub typhus in 2008.In 2013 during dengue outbreak in the state numbers of scrub typhus cases reported in STNM Hospital. Due to timely intervention no death reported due to scrub typhus or dengue in 2013.So scrub typhus is not uncommon in our region. Unfortunately in the past due to delay in Lab diagnosis and treatment few patients succumbed to illness in 2008.

HABITATS FAVORABLE FOR DISEASE TRANSMISSION

Scrub typhus, originally found in scrub jungles, has also been identified in a variety of other habitats, such as sandy beaches, mountain deserts and equatorial rain forests.

INCUBATION PERIOD

Incubation Period: 1 – 3 weeks.

DIAGNOSIS AND TESTING
• The symptoms of scrub typhus are similar to symptoms of many other diseases. See your health care provider if you develop the symptoms listed above after spending time in areas where scrub typhus is found.
• If you have recently traveled, tell your health care provider where and when you traveled.
• Your health care provider may order blood tests to look for scrub typhus or other diseases.
• Laboratory testing and reporting of results can take several weeks, so your health care provider may start treatment before results are available.

TREATMENT
• Scrub typhus should be treated with the antibiotic doxycycline and chloramphemicoil. Doxycycline can be used in persons of any age.
• Antibiotics are most effective if given soon after symptoms begin.
PREVENTION

• No vaccine is available to prevent scrub typhus.
• Reduce your risk of getting scrub typhus by avoiding contact with infected chiggers.
• When traveling to areas where scrub typhus is common, avoid areas with lots of vegetation and brush where chiggers may be found.

RECOMMENDATION
It is Advised:-
1. Patient presenting with above symptoms should visit the PHC/PHSC early for treatment.
2. Delay in treatment leads to complication and death.
3. Drugs like doxycycline, chloramphemicoil are treatement of choice.
4. Testing facility of scrub typhus is available in PHC, District Hospital and STNM Hospital.
5. To keep the surrounding and household area clean.
6. To maintain personal hygiene wash and clean clothing after coming back from forest and work area in village.
7. To avoid drying of clothing on the bushes and scrubs at villages.
8. Do not neglect any kind of insect bite to report at nearest hospital for treatment. Scrub typhus is curable and treatable if reported on time.
9. Since there is no Vaccines available for scrub typhus and causative insect are present in scrubs and bushes best way is to remain alert and take early treatments to avoid scrub typhus.PRESENT SCENARIO IN SIKKIM
Cases of scrub typhus are being reported from the different district of the state in the past few months where west district has reported more numbers of cases as compared to other districts. Out of the 51 cases reported in July and 60 cases reported in August 2017, 3 tested positive for scrub typhus in July and 9 tested positive in August, rest were tested negative for scrub typhus in District Hospital Gyalshing. Unfortunately 6 deaths were reported from District Hospital Gyalshing during July-Sept 2017, out of which 2 deaths are laboratory confirmed deaths due to scrub typhus. Rest of the death was suspected due to scrub typhus as no Lab confirmation report was present. The Unfortunate deaths were due to delay in seeking treatments at the hospital.
Action taken by the Health Department:-
1. Information Education Communication (IEC) and awareness on scrub typhus is being given at the local areas in the west district and other districts.
2. Information given to the Center Surveillance Unit regarding the outbreak of scrub typhus and State Surveillance Unit Health Department is in touch with CSU Delhi.
3. Districts, PHCs and PHSCs are directed to remain vigilant on reporting of fever cases. Suspected cases to be tested for scrub typhus and early treatment of individual is advised.